Autoimmune Conditions
Muscular Dystrophy
Full Critical Illness Benefit Criteria
An unequivocal diagnosis by an appropriate specialist of muscular dystrophy.
Systemic Lupus Erythematosus (SLE) with Lupus Nephritis
Full Critical Illness Benefit Criteria
An unequivocal diagnosis by an appropriate specialist of SLE that confirms any four of the criteria in the following table:
| Criteria | Definition |
|---|---|
| Malar rash | Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds |
| Discoid rash | Erythematosus, raised patches with adherent keratotic scaling and follicular plugging, atrophic scarring may occur in older lesions |
| Photosensitivity | Skin rash because of unusual reaction to sunlight, shown by patient history or specialist report |
| Oral ulcers | Oral or nasopharyngeal ulceration reported by a specialist |
| Arthritis | Non-erosive arthritis involving two or more peripheral joints, characterised by tenderness, swelling, or effusion |
| Serositis | Pleuritis – convincing history of pleuritic pain or pleuritic rub heard by a specialist or evidence of pleural effusion OR Pericarditis – documented by ECG or rub or evidence of pericardial effusion |
| Renal disorder | Persistent proteinuria greater than 0.5 grams/24hr or greater than 2+ if quantitation not performed OR Tubular casts – may be red cell, haemoglobin, granular, cellular or mixed |
| Neurological disorder | Seizures – without offending drugs or known metabolic derangements, such as uraemia, ketoacidosis or electrolyte imbalance |
| Hematologic disorder | Hemolytic anaemia – with reticulocytosis OR Leucopoenia – less than 3,500/mm3 on two or more occasions OR Thrombocytopenia – less than 100,000mm3 without offending drugs |
| Immunologic disorder | Positive LE cell preparation OR Anti-DNA: antibody to native DNA in abnormal titre OR Anti-Sm: presence of antibody to Sm (Smooth Muscle) nuclear antigen OR False positive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema pallidum immobilisation or fluorescent treponemal antibody absorption test |
| Antinuclear antibody | An abnormal titre of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and without drugs known to be associated with ‘drug-induced lupus’ syndrome |
As well as the diagnosis of SLE, renal changes must confirm the life assured has lupus nephritis. A renal biopsy must measure class 3 to 6 of the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis. The lupus nephritis must also be associated with persisting proteinuria (more than 2+).
Systemic Sclerosis
Full Critical Illness Benefit Criteria
An unequivocal diagnosis by an appropriate specialist of systemic sclerosis that causes the total and irreversible inability to perform at least one of the activities of daily living without the help of another adult.
Diagnosis Criteria
An unequivocal diagnosis by an appropriate specialist of systemic sclerosis.